Role: Senior Healthcare Interoperability Engineer

Location: 100% Remote

Requirements (Must Have):

· Strong C# developer (7+ years) building complex APIs in .NET 8.0 or higher

· Deep FHIR expertise: FHIR R4 specification, resource modeling, profiles, extensions, Implementation Guides

· CMS Interoperability Final Rule knowledge: Patient Access, Provider Access, Payer-to-Payer, Prior Authorization requirements

· Da Vinci FHIR IG experience: PDex, CDex, PAS (Prior Authorization), HRex, DTR (Documentation Templates and Rules)

· Proven experience building FHIR-compliant APIs from scratch (not just configuration)

· HL7 v2.x and HL7 v3 expertise: message structure, parsing, validation, transformation (especially X12 278 for prior auth)

· US Core Data for Interoperability (USCDI) v3/v4 implementation

· SQL Server expertise: complex queries, stored procedures, performance tuning, healthcare data modeling

· Experience with clinical terminologies (LOINC, SNOMED CT, RxNorm, ICD-10, CPT, HCPCS)

· Familiar with Azure services (App Service, API Management, Service Bus, Key Vault)

· Understanding of FHIR server internals: resource persistence, search parameters, indexing strategies

Note: This role requires deep expertise in CMS 2027 compliance requirements including all four mandated APIs (Patient Access, Provider Access, Payer-to-Payer, Prior Authorization) plus Provider Directory. Experience with Da Vinci FHIR Implementation Guides and payer operations is highly valued. We need someone who can both integrate with Smile CDR AND architect custom FHIR infrastructure for long-term sustainability.

Preferred Skills (Nice to Have):

Smile CDR & FHIR Repositories:

· Hands-on Smile CDR configuration, customization, and integration

· Linux system administration for healthcare applications

· Smile CDR module configuration (FHIR Storage, Subscriptions, Security)

· Custom interceptor development for business logic

· Experience with other FHIR servers (HAPI FHIR, Firely Server, Azure API for

FHIR)

CMS 2027 Compliance - Specific APIs:

· Patient Access API (PDex, US Core profiles, member history, formulary data)

· Provider Access API (claims, encounters, clinical data for providers treating patients)

· Payer-to-Payer Data Exchange (bulk FHIR, patient transitions between payers)

· Prior Authorization API (PAS IG, X12 278 to FHIR conversion, real-time authorization requests)

· Provider Directory API (National Directory, NDH profiles, provider onboarding workflows)

Advanced Healthcare Interoperability:

· Experience building custom FHIR servers or repositories

· Prior Authorization workflow implementation: request submission, status tracking, documentation requirements (DTR)

· CRD (Coverage Requirements Discovery): CDS Hooks integration for prior auth determination

· FHIR Bulk Data API ($export operations) for payer-to-payer exchange

· FHIR subscriptions and notifications

· SMART on FHIR, OAuth 2.0, OIDC, UDAP implementation

· Provider attestation and credentialing workflows

· Claims data to FHIR mapping (CARIN IG for Blue Button)

· Pharmacy formulary and drug coverage (Formulary IG)

· Member attribution and roster management